Atherectomy devices and methods
Rotational atherectomy devices and systems can remove or reduce stenotic lesions in blood vessels by rotating one or more abrasive elements within the vessel. The abrasive elements can be attached to a distal portion of an elongate flexible drive shaft that extends from a handle assembly that includes a driver for rotating the drive shaft. In particular implementations, individual abrasive elements are attached to the drive shaft at differing radial angles in comparison to each other (e.g., configured in a helical array). The centers of mass of the abrasive elements can define a path that fully or partially spirals around the drive shaft. In some embodiments, a distal stability element with a center of mass aligned with the longitudinal axis is fixedly mounted to the drive shaft.
1. A method for performing rotational atherectomy to remove stenotic lesion material from a blood vessel of a patient, the method comprising:
delivering a rotational atherectomy device into the blood vessel, wherein the rotational atherectomy device comprises:
an actuator handle assembly comprising a housing and a carriage assembly that is movably coupled to the housing;
an elongate flexible drive shaft comprising a torque-transmitting coil, the drive shaft defining a longitudinal axis and a central drive shaft lumen extending along the longitudinal axis, the drive shaft rotatably coupled to the carriage assembly;
a set of eccentric abrasive elements fixed to a distal portion of the drive shaft and including at least a first, second, and third eccentric abrasive elements fixed to the drive shaft such that a center of mass of each eccentric abrasive element is offset from the longitudinal axis, the center of mass of the first eccentric abrasive element being offset from the longitudinal axis at a first radial angle, the center of mass of the second eccentric abrasive element being offset from the longitudinal axis at a second radial angle that differs from the first radial angle, the center of mass of the third eccentric abrasive element being offset from the longitudinal axis at a third radial angle that differs from the first radial angle and the second radial angle;
a sheath extending distally from a distal end of the actuator handle assembly and configured to receive a supply of flush fluid, the drive shaft being slidably disposed within a lumen defined by the sheath;
an electric motor coupled to the carriage assembly and configured to drive rotation of the drive shaft; and
a guidewire detention clamp positioned adjacent to a guidewire access port at a proximal end of the actuator handle assembly opposite from the sheath extending distally from the distal end of the actuator handle assembly and coaxial with the drive shaft;
moving the carriage assembly in relation to the housing to correspondingly move the drive shaft in relation to the housing; and
activating the electric motor for driving rotation of the drive shaft at a rotational speed of 20,000-160,000 rpm to urge the set of eccentric abrasive elements to revolve in an orbital path.
2. The method of claim 1 , wherein the electric motor is activated by a motor switch button movable with the carriage assembly relative to the housing.
3. The method of claim 1 , further comprising:
engaging the guidewire detention clamp with a guide wire advanced through the actuator handle assembly and the drive shaft so as to releasably clamp the guidewire in a stationary position during rotation of the drive shaft.
4. The method of claim 1 , wherein the guidewire is configured to extend distally from the actuator handle assembly through the central drive shaft lumen and to extend proximally from the guidewire access port at a proximal end of the actuator handle assembly.
5. The method of claim 1 , further comprising preventing, by the guidewire detention clamp, the guidewire from rotating while the drive shaft is rotating.
6. The method of claim 5 , further comprising preventing, by the guidewire detention clamp, the guidewire from translating while the carriage assembly is translated in relation to a housing of actuator handle assembly.
7. The method of claim 5 , wherein the rotational atherectomy device further comprises a concentric abrasive distal element having a cylindrical shape with an abrasive exterior coating and a center of mass aligned with the longitudinal axis, the concentric abrasive distal element fixed to the drive shaft and distally spaced apart from a distal-most abrasive element of the set of eccentric abrasive elements by a distal separation distance.
8. The method of claim 1 , wherein a proximal-most abrasive element of the set of eccentric abrasive elements and a distal-most abrasive element of the set of eccentric abrasive elements have outer diameters that are no greater than outer diameters of respectively adjacent abrasive elements in the set of eccentric abrasive elements and that are greater than an outer diameter of a concentric abrasive distal element.
9. The method of claim 1 , wherein the set of eccentric abrasive elements further comprises:
a fourth abrasive element attached to the distal portion of the drive shaft, wherein the center of mass of the fourth abrasive element is offset from the longitudinal axis along a fourth radial angle that differs from the first radial angle, the second radial angle, and the third radial angle; and
a fifth abrasive element attached to the distal portion of the drive shaft, wherein the center of mass of the fifth abrasive element is offset from the longitudinal axis along a fifth radial angle that differs from the first radial angle, the second radial angle, the third radial angle, and the fourth radial angle.
10. The method of claim 9 , wherein:
the second radial angle differs from the first radial angle by 20 degrees to 50 degrees,
the third radial angle differs from each of the first radial angle and the second radial angle by 20 degrees to 50 degrees,
the fourth radial angle differs from each of the first radial angle, the second radial angle, and the third radial angle by 20 degrees to 50 degrees, and
the fifth radial angle differs from each of the first radial angle, the second radial angle, the third radial angle, and the fourth radial angle by 20 degrees to 50 degrees.
11. The method of claim 9 , wherein a proximal-most abrasive element and a distal-most abrasive element are both smaller than all abrasive elements of the set of eccentric abrasive elements positioned between the proximal-most and the distal-most abrasive elements.
12. The method of claim 11 , wherein the centers of mass of the set of eccentric abrasive elements define a spiral path around the longitudinal axis.
13. The method of claim 9 , wherein where each of the eccentric abrasive elements of set of eccentric abrasive elements is equal in outer diameter.
14. The method of claim 13 , wherein the centers of mass of the eccentric abrasive elements define a spiral path around the longitudinal axis.
15. The method of claim 1 , wherein the rotational atherectomy device further comprises a controller coupled to the actuator handle assembly and configured to provide output to the electric motor within the actuator handle assembly.
16. The method of claim 15 , wherein the controller includes a user interface with a plurality of selectable speed buttons corresponding to drive shaft rotation speed settings.
17. The method of claim 16 , wherein the controller includes a display screen to provide the user interface.
18. The method of claim 16 , wherein the controller includes a user interface with a flush fluid pump activation button.
19. The method of claim 1 , wherein the torque-transmitting coil comprises one or more helically wound filars.
20. The method of claim 19 , wherein the filars are wound in an opposing direction to a spiral path defined by the centers of mass of the eccentric abrasive elements of the set of eccentric abrasive elements.